key: cord-0986305-elhpdeg1 authors: Mosby, Ian; Swidrovich, Jaris title: Medical experimentation and the roots of COVID-19 vaccine hesitancy among Indigenous Peoples in Canada date: 2021-03-15 journal: CMAJ DOI: 10.1503/cmaj.210112 sha: 7bebf62dfd7a0055a3b037db6b7d3f32013e1dec doc_id: 986305 cord_uid: elhpdeg1 nan A s the second wave of the pan demic sees case numbers rise to dangerous levels across the country, it has become clear that Indigen ous people are particularly vulnerable to coronavirus disease 2019 (COVID19). The figures released by the Manitoba First Nations COVID19 Pandemic Response Coordination Team reflect this vulnerabil ity. Despite making up just over 10% of the total population of the province, First Nations people make up 71% of active cases with COVID19 and 50% of patients in the intensive care unit; the median age of death from COVID19 for First Nations people is 66 compared with the provincial median of 83 for Manitobans, overall. 1 This should come as no surprise to anyone who has read the dozens of stud ies, reports and royal commission find ings published during the past two decades. Study after study has shown the vulnerability of First Nations, Métis and Inuit communities to health crises like the one we are currently facing. This vulnerability is very much the product of a Canadian colonial policy regime that has guaranteed that Indigenous Peoples have reduced access to adequate health care, healthy food and clean water, while also experiencing much greater levels of overcrowded housing, homelessness and incarceration. All of these factors increase the possi bility both of contracting COVID19 and of having severe health complications as a result. It is therefore imperative that Indigen ous Peoples receive priority access to vaccines for severe acute respiratory syndrome coronavirus 2 (SARSCoV2). However, many Indigenous people have expressed substantial hesitancy and even opposition to vaccination for COVID 19. After the arrival of 1200 doses of the Moderna vaccine in his home community, former Assembly of First Nations National Chief Matthew Coon Come articulated his concerns in a widely shared social media post, writing "Mistissini is now the experi mental rats of this experimental vaccine." 2 The fears and hesitancy articulated by Coon Come are, of course, not universal, and many Indigenous leaders have come out strongly in support of vaccines. How ever, the reality is that these concerns are nonetheless widely held by many First These concerns, fears and experiences need to be taken seriously by doctors and other health care professionals and need to be differentiated from the "antivax" movements that have thrived on social media in recent years. The reality is that welldocumented examples of Indigenous Peoples being subjected to medical experi mentation exist. One of the authors of this article has published research regarding a series of nutrition experiments conducted in several Manitoba Cree communities in the 1940s, as well as in six residential schools between 1948 and 1952. 4 Historian Maureen Lux has similarly documented multiple instances of medical experimen tation on Indigenous Peoples, including a 12year trial of the experimental bacille CalmetteGuérin vaccine for tuberculosis on Cree and Nakoda Oyadebi infants in Saskatchewan during the 1930s and 1940s. 5 A whole range of experimental sur gical and drug treatments were also administered to Indigenous patients, with out their consent, within Canada's racially segregated system of Indian Hospitals dur ing the early postwar years. 5 The legacies of the racist paternalism that left Indigenous Peoples uniquely vul nerable to medical experimentation and abuse can be seen in the more recent story of Brian Sinclair, who died as a direct result of racist treatment at the hands of hospital staff and physicians. They can also be seen in the testimony of nearly 60 Indigenous women who launched a class action lawsuit seeking damages for what they describe as forced sterilizations by Saskatchewan doc tors over the past 25 years. 6 Indigenous Peoples, then, have every reason to be wary of the Canadian medical system. Given that recent studies show that Black people, in particular, are much more likely to reject SARSCoV2 vaccination than their White counterparts -in large part because of welldocumented experiences of medical abuse and experimentationwe need to start taking this seriously. 7 The influenza A virus (H1N1) pandemic is an instructive example of vaccine hesi tancy among Indigenous Peoples. As studies have shown, Indigenous Peoples' experi ences of Canadian colonialism already "deeply affected their perceptions of the [H1N1] vaccine and pandemic" and increased vaccine hesitancy. 8 These issues were then exacerbated by problematic public health messaging and actions. A disturbing example of this occurred in 2009 when, during an H1N1 outbreak, the federal government sent body bags to four Mani toba First Nations communities instead of shipments of antivirals, hand sani tizer and flu kits. 9 The story spread and con tributed to distrust across the country. Although there is no genetic predisposition to or additional risk of more severe outcomes from H1N1 for Indigenous Peoples, they were nonetheless listed as a standalone category of people who should receive the H1N1 vac cine among all identified highrisk groups. Zeroing in on Indigeneity alone meant that many were left feeling like guinea pigs. 9 Canada is already setting itself up for similar failures with the SARSCoV2 vac cines. Limited and late information about both COVID19 and the approved vaccines have each contributed to vaccine hesi tancy among Indigenous Peoples. 10 It also means that those on the ground are being asked to fill an informational vacuum among an already skeptical population with few resources. The lack of information is why Lesa Semmler, member of the Legis lative Assembly in Inuvik and a former nurse, has been pushing for community focused and communitydriven educa tional efforts. "People need time," she told the CBC. "You need the health education before [the vaccines arrive]." 10 Similar to the H1N1 pandemic, then, the prioritization of Indigenous Peoples and communities to receive SARSCoV2 vaccines raises questions. Recent state ments that Canada could not meet its pledge to end boil water advisories by March 2021 because of COVID19 -all while early priority shipments of the vac cine are being sent to Indigenous com munities -only feeds into the narrative that Indigenous Peoples are being used to test the safety and effectiveness of the vaccine before it is administered to the rest of the population. What, then, needs to be done to ensure that as many Indigenous people as possi ble receive SARSCoV2 vaccines that we, the authors, believe to be lifesaving? For a start, doctors and other health professionals need to educate themselves before going into communities to admin ister vaccines. Too many are unaware of Canada's shameful histories of racially segregated health care and medical experimentation, and therefore misun derstand the nature of vaccine hesitancy. Public health messaging about the risks of SARSCoV2 infection and the bene fits of receiving the vaccine also must clearly be positioned in a way that speaks to Indigenous Peoples' historical and contemporary experiences with Canadian settler colonialism. Risk attri butes must also be described individually rather than simply categorizing Indigen eity as an individual risk category. This means jettisoning a onesizefitsall public health messaging strategy. Pandemic messaging will be more effective if delivered directly by Indigenous Elders, leaders and health practitioners who have trust and credibility in their communities. For many communities, this means that public health messaging needs to focus not only on the health and wellness of the people receiving the vaccine, but also on the health and well ness of our families, communities, the land and the next seven generations. One of the, perhaps insurmountable, shortterm problems that we face is that there has never been a reckoning for the legacy of medical experimentation and other abuses targeted at Indigenous Peo ples within Canadian medical institutions. In the long term, an inquiry into the his tory of medical experimentation in Can ada and reparations to the affected com munities will be required. Before that happens, though, there also needs to be a vaccine strategy that puts the onus on Canada for doing what is necessary to prove to Indigenous com munities that the vaccine is safe, effective and in their best interests. And this should have started months ago. Manitoba First Nations COVID19 Pandemic Response Coordination Team Weekly Bulle tin. Winnipeg: Assembly of Manitoba Chiefs Former AFN national chief and Cree grand chief speaks out against vaccine To tackle vaccine hesitancy, Canada can't ignore race, racism: health experts. CTV News: Coronavirus Administering colonial science: nutrition research and human biomedical experimentation in Aboriginal communities and residential schools Separate beds: a history of Indian hospitals in Canada, 1920s-1980s Indigenous women kept from seeing their newborn babies until agreeing to sterilization, says lawyer Correlates and disparities of intention to vaccinate against COVID19 Factors influencing H1N1 vaccine behavior among Manitoba Metis in Canada: a qualitative study Communicating risk to Aboriginal Peoples: First Nations and Metis responses to H1N1 risk messages Work with communities to address vaccine hesitancy, say Indigenous leaders. CBC News North This article has been peer reviewed Content licence: This is an Open Access article distributed in accordance with the terms of the Creative Commons Attribution (CC BYNCND 4.0) licence, which permits use, distribution and reproduction in any medium, provided that the original publication is properly cited, the use is noncommercial (i.e., research or educational use), and no modifications or adaptations are made. See: https://creativecommons.org/ licenses/byncnd/4.0/